Archive: What discount will I receive for my tier 5 specialty drugs when I am in the Medicare Part D Donut Hole?

So, if you purchase a Tier 5 drug - or even a Tier 1 generic - or a Tier 2 Preferred Multi-Source drug in the Coverage Gap, you will receive the Donut Hole discount of 75% (you pay 25% of retail).

• The only difference is that when you purchase generic drugs in the Donut Hole you get credit for the 25% you paid out-of-pocket toward meeting your out-of-pocket limit (RxMOOP) and exiting the Donut Hole.
  
  
• However, when you purchase a brand-name drug in the Donut Hole, you will receive the brand-name Donut Hole discount of 75% (you pay 25% of retail) - and with brand-name drugs you get credit for 95% of the retail drug price (the 25% you pay plus the 70% that the brand-name pharmaceutical drug manufacturer pays) toward meeting your out-of-pocket threshold (RxMOOP) and exiting the Donut Hole.
  
  For example, if your Medicare Part D plan covers the weight loss drug Wegovy® for plan member who also have additional accepted medical indications (such as a chronic heart conditions or diabetes), your medication may be covered as a Tier 5 Specialty Drug with 33% cost-sharing and a $1,400 retail cost.  So, when you reach the Donut Hole, you will pay 25% of the retail price ($350) and receive credit toward exiting the Donut Hole of 95% of the retail drug price or $1,330.